Provider Demographics
NPI:1932582400
Name:COLASACCO, GRACE (LMHC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:COLASACCO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 S 1ST ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4930
Mailing Address - Country:US
Mailing Address - Phone:631-741-6699
Mailing Address - Fax:
Practice Address - Street 1:138 S 1ST ST
Practice Address - Street 2:SUITE 115
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4930
Practice Address - Country:US
Practice Address - Phone:631-741-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health